NPIMap

Organization Active NPI

Marshall Medical Center South

Doing business as Medical Center OBGYN

  • Obstetrics & Gynecology Physician
  • Boaz, AL
National Provider Identifier
1639321789
Registry record updated Mar 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
28483 Issued in AL
Legal business name
MARSHALL MEDICAL CENTER SOUTH
Doing business as
Medical Center OBGYN
Practice address
2525 US Highway 431
210
Boaz, AL 35957-5934
Phone
(256) 840-4601
Fax
(256) 840-4613
NPI assigned
Oct 21, 2008
Last updated
Mar 14, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Taylor M Walker
Title
Cfo
Phone
(256) 894-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 28483 AL Primary

Addresses

Primary practice location

2525 US Highway 431
210
Boaz, AL 35957-5934

Mailing address

2525 US Highway 431
210
Boaz, AL 35957-5934
Phone (256) 840-4601

Other identifiers 1

IdentifierTypeStateIssuer
1114948270OtherALNPI INDIVIDUAL

Other names 1

  • Medical Center OBGYN Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081216000593 AL Part B Supplier - Clinic/Group Practice 1153483797 Receives reassigned benefits from 12 practitioners
Practice locations: Boaz, AL; Guntersville, AL; Huntsville, AL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2505 US Highway 431
Ste B
Boaz, AL 35957
Phone (256) 840-3396

2525 US Highway 431
Ste 200
Boaz, AL 35957
Phone (256) 593-2221

55 Rowe Dr
#A
Guntersville, AL 35976
Phone (256) 571-8470

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552521600000",
    "number": "1639321789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 US HIGHWAY 431",
            "address_2": "210",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "359575934",
            "telephone_number": "256-840-4601",
            "fax_number": "256-840-4613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 US HIGHWAY 431",
            "address_2": "210",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "359575934",
            "telephone_number": "256-840-4601",
            "fax_number": "256-840-4613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL MEDICAL CENTER SOUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2019-03-14",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "256-894-6600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AL",
            "license": "28483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1114948270",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Center OBGYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boaz, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.